Provider Demographics
NPI:1114332178
Name:ANTLEY, NATALIA NUNEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:NUNEZ
Last Name:ANTLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2329 DEVINE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2431
Mailing Address - Country:US
Mailing Address - Phone:803-799-3368
Mailing Address - Fax:803-799-3504
Practice Address - Street 1:2329 DEVINE ST STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2431
Practice Address - Country:US
Practice Address - Phone:803-799-3368
Practice Address - Fax:803-799-3504
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85781223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice